TB and HIV - the co-epidemic

World AIDS Day

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30 November 2007 - WHO Director-General, Dr Margaret Chan, has reminded the world that more must be done to address the TB and HIV co-epidemic on World Aids Day. In a statement released for 1 December 2007, she concluded:

"Finally, another thing we can do right now is manage the co-epidemic of tuberculosis. Without access to antiretroviral therapy and proper TB treatment, most people living with HIV who develop tuberculosis will die quickly, sometimes in a matter of weeks. Effective joint interventions exist for both TB and HIV, and these need to be scaled up in an integrated fashion to prevent these unnecessary deaths."

Her comments were echoed by the WHO Stop TB Director, Dr Mario Raviglione. In an interview for World Aids Day, he outlined the progress WHO Stop TB is making to reduce mortality caused by HIV associated TB, through its policies to strengthen collaboration between the TB and HIV sectors.

Interview with WHO Stop TB Director, 1 December 2007, WHO, Geneva

Question: The Director-General of WHO, Dr Margaret Chan in her World AIDS Day message, concluded by calling for the scaling up of TB/HIV collaborative activities. What are the challenges or obstacles for scaling up these activities?

Mario Raviglione: Scaling up is a top priority for the world today. We have to make sure that all countries, all NGOs, all people working on TB and on HIV collaborate at a level where the impact can be seen and felt at national level. The HIV community, like the TB community, and those that work in the field need to adhere to certain recommendations that have been made by the world experts - this has to be a priority action.

For me the key obstacles to achieving this are still a certain lack of commitment; a certain lack of awareness of what the actual interventions are; and finally the issues around putting these policies into practice i.e. the feasibility of putting these interventions into play at the country level.

The policy around collaboration is extremely clear:

Every country must establish a mechanism for collaboration - a sort of committee on TB/HIV- that can coordinate the inputs of the two programmes at a national level.

The precise interventions are listed under two categories i) Those that decrease the burden of TB in people living with HIV/AIDS and ii) those that aim to decreasing the burden of HIV in TB patients.

In more detail we are talking about:

intensified TB case finding among people living with HIV;

the introduction of Isoniazid Preventive Therapy;

the assurance that infection control practices are in place;

the provision of HIV testing and counseling;

the introduction of HIV prevention methods;

the introduction of co-trimoxazole preventive therapy;

the assurance that HIV and AIDS care and support services are present;

finally the introduction of ARVs, using the channel of newly-diagnosed TB patients.

Question: How will this policy impact on the individual? What advice should you give those who may fear they are at risk from TB/HIV?

MR: If a person suspects they are HIV positive, the first thing they must do is clearly get tested. If a person knows he or she is HIV positive and doesn't feel well, i.e. has symptoms of TB which are coughing, fever and losing weight then please check for TB. This is really extremely important. It is important that the person thinks about TB all the time when there are symptoms of that type, because TB, when it is caught on time, it is absolutely curable in everyone, including those living with HIV/AIDS.

Question: Infection control has been put firmly on the agenda recently. What is WHO Stop TB Department doing to make sure that measures are strengthened in this area?

MR: This is certainly a priority target for us now and for the next few years. Infection control is an issue that has been neglected by many - and it is not just an issue for TB programme managers - it is an issue for those involved in the management of hospitals, clinics, and public health infrastructures.

We need to ensure that the basic elements, whether they are administrative or environmental, are really conducive to better infection control, that the policies and measures are in place to reduce the risks of transmission of the diseases like TB. We are working towards a general policy on this that we will then disseminate and adapt per country and per region in the world, in such a way that can minimize the risks of transmission of a disease like TB among HIV positive people.

Question: Will you be issuing any new data around TB/HIV?

MR: Yes, in January 2008 we will publish new data on the global TB/HIV figures. This data will also detail country by country and globally the progress that is being made on TB/HIV collaborative activities.

In November, I saw for myself the tremendous impact that HIV and TB activists can have in raising the importance of addressing this co-epidemic. For the first time ever, 5,000 people marched on the streets of Cape Town in South Africa demanding improvements in all areas to address TB and HIV. This sort of TB movement, and this sort of event needs to be repeated everywhere and every month. People need to understand how important the burden of TB is among patients living with HIV.

The more we are capable of empowering communities and ensuring their voices are raised in protest against the inaction of governments and leaders, then the better chances we have of reaching global targets for reducing the burden of TB, and eventually a world free of TB.